|
' "R[7°" CERTIFICATE OF LIABILITY INSURANCE
<br />--DATEIMM,DD/YYYYI
<br />2/1/2019
<br />THIS OERT'IFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THR POLICIES
<br />EELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(8), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder la an ADDITIONAL INSURED, the pollcy(les) must have ADDITIONAL INSURED provisions or ba endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the pclldy, certain policies may require an endorsement, A statement on
<br />this certificate does not confer rights to the certificate holder in Neu of suoil endorsements).
<br />PRODUCER
<br />Arthur J. Gallagher & Co.
<br />Insuran0e Brokers of CA, Inc. LIC #0726293
<br />NA
<br />it.o
<br />T MDMMcDonald
<br />oNE
<br />�A7c
<br />PA
<br />N¢ Eve • 818.539 862E P/O o • 818.539,8725�
<br />E.Ir�I IC"
<br />mauroen mGdonald(3elg,aom
<br />606 N Brand Blvd, Suite 600
<br />Glendale CA 91203
<br />�I,[(,$,{1,RaR(SIAFPtlR01NG COVERAGE
<br />�^^
<br />LAID
<br />eURe • Borkle Nalonal Insurance Company
<br />38911
<br />INSURED INT59OU43
<br />Interval $5
<br />P.O, Boxox$366
<br />INSURER 0•L14 d'sSyndicate 2987
<br />M aulumo:GreetAmericanSpiritInsuranceComan
<br />_
<br />�S3723
<br />INSURER D. New York Marine And General Insurance Company
<br />16-,..,.,.,_.6084
<br />Seal Beach, CA 90740
<br />INSURER E v
<br />SURER F:
<br />COVERAGES CERTIFICATE NUMBER: 1f1nRRAn94A 1AWWAlnM MIIaelgco,
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISBUBD TD 'rFIE INSURED NAMED ABOVE FOR THE POLICY PERICD
<br />INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONSANO CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />rL SR
<br />TYPE OFINSURANCB
<br />OAUSUB
<br />L
<br />POLICYNUMRB
<br />PO P`
<br />P
<br />LIMITS
<br />A
<br />X
<br />C0MMERCIALGENERALLIABILIrY
<br />CLAIMS -MADE M OCCUR
<br />Y
<br />INHS952562042
<br />10/112018
<br />10/112019
<br />8ACHOCCURRENCE
<br />loo(LoG0
<br />P A a¢ cannot
<br />1500,000 —_
<br />MSD EXP (Any aneper!E
<br />_..._
<br />$10,000
<br />PERSONAL& ACV INJURY
<br />1,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />'� POLICY 0 JQOT ❑ LCC
<br />GENERALAOOREOATa
<br />S3000,000
<br />PROOUCTS •COMPrOP AGO
<br />3,000.000
<br />S
<br />OTHER•
<br />AUTaMORILBUADILITY
<br />._..
<br />ANYAUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY ppLL�1T09
<br />HIRED NON-OIAMEd
<br />AUTOS ONLY AUTOS ONLY
<br />a occiNtl, ING —LIMIT'"'
<br />..LAB]--,—__..
<br />§
<br />BODILY INJURY IPw Person)
<br />§
<br />BODILY INJURY IPer peaiganl )
<br />§ _�-
<br />PROPERTY AMAOa
<br />Per accltl¢nt
<br />'$
<br />R
<br />UMRRELLALIAR
<br />X
<br />OCCUR
<br />NPXS20180025
<br />10114010
<br />101112010
<br />EACH OCCURRENCE
<br />$2,000,000
<br />X
<br />Excess LIAR
<br />CLAIMS -MADE
<br />AGGREGATE
<br />$2.010000
<br />DED I X I RETeNTI N IS n$
<br />0
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILIrY YIN
<br />ANYPROPRIaTOR/PARTNER/EXECUTIVE
<br />OFFICER NEMBEREXCLUDED7
<br />NIA
<br />W0201900005078
<br />211/2019
<br />2/1/2020
<br />E,L. EACH ACCIDENT
<br />$1008000
<br />a.L. DISEASE• EA EMPLOYEE
<br />$1,000,010
<br />IfMy nd.t r IF unldor
<br />OESORIFTIONOFOPBRATIONSbelow
<br />8,L, DISEASE • POLICY LIMIT
<br />$1.000,000
<br />c
<br />CyymrLloblNy
<br />Claims -Made form
<br />Rmre Dme:71lpn1p
<br />NET 1280-6-74-03
<br />10/1/201a
<br />10/1/2019
<br />LIMIT
<br />Ag%egnla
<br />ReanGGOon
<br />Si,000tl00
<br />$1,000:00on
<br />S5,OOtl
<br />DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES IACORD 101, Addltlonnl Ramarea Schaduc, MAY be atlached if mom space to required)
<br />Polley, Crime Coveragge
<br />Policy Term: 12/01/2018 To 10/01/2019
<br />Policy Number; UC11717955.18.038
<br />Carrier: Underwriters at Lloyyd's, London
<br />ERp$A: then $3,000,0001 Deductible: $25,000
<br />ER 0,000.000
<br />Theft of money and aBOur,000,0 01 Ded 0 /Deductible : $25,000
<br />SMoneyao At and Securities: $3,000,000I Deductible : $26,000
<br />Sae Attached...
<br />The City of Santa Ana
<br />20 Civic Center Plaza
<br />Santa Ana CA 92701
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />0198E-20116 ACORD
<br />ACORD 26 (2016103) The ACORD name slid logo are roglatarod marks of ACORD
<br />:.1
<br />
|